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Organization

INTEGRATED COMMUNITY ONCOLOGY NETWORK LLC

Active
Other names
Kasraeian Urology Divison of ICON
Organization subpart
No

Provider details

NPI number
Authorized official
AHMAD KASRAEIAN MD (KASRAEIAN UROLOGY DIVISION MANAGER)
(904) 727-7955
Entity
Organization

Contact information

Practice address
6269 BEACH BLVD, SUITE 2, JACKSONVILLE, FL 32216-2768
(904) 727-7955
(904) 727-7976
Mailing address
6269 BEACH BLVD, SUITE 2, JACKSONVILLE, FL 32216-2768
(904) 727-7955
(877) 406-4796

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
273427300
FL
Enumeration date
01/06/2011
Last updated
06/15/2012
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